Abstract
BackgroundIn the aging population cardiovascular disease (CVD) is highly prevalent. Identification of very old persons at high risk of recurrent CVD is difficult, since traditional risk markers loose predictive value with age. MethodsIn a population-based sample of 282 85-year old participants with established CVD from the Leiden 85-plus Study, we studied predictive values of traditional cardiovascular risk markers, a history of major CVD (myocardial infarction, stroke or arterial surgery), and new cardiovascular biomarkers (estimated glomerular filtration rate (MDRD), C-reactive protein (CRP), homocysteine and N-terminal pro B-type natriuretic peptide (NT-proBNP)) regarding 5-year risk of recurrent cardiovascular events and mortality (composite endpoint).ResultsDuring complete 5-year follow-up 157 (56%) participants died. 109 (39%) had a cardiovascular event or died from cardiovascular causes. Individually related to the composite endpoint were: a history of major CVD (HR 1.5 (95%CI 1.03-2.3)), CRP (HR 1.3 (95%CI 1.03-1.5)), homocysteine (HR 1.4 (95%CI 1.2-2.6)) and NT-proBNP (HR 1.7 (95%CI 1.4-2.1)). A prediction model including all traditional risk markers yielded a C-statistic of 0.59 (95%CI 0.52-0.66). Of all five new markers only addition of NT-proBNP improved the C-statistic (0.67 (95%CI 0.61-0.74, p=0.023)). The categoryless net reclassification improvement for NT-proBNP was 39% (p=0.001), for a history of major CVD 27.2% (p=0.03) and for homocysteine 24.7% (p=0.04). ConclusionsAmong very old subjects with established CVD, NT-proBNP was the strongest risk marker for cardiovascular events and cardiovascular mortality. When estimating risk in secondary prevention in very old age, use of NT-proBNP should be considered.
Highlights
In the aging population, cardiovascular disease (CVD) is highly prevalent and remains a leading cause of death [1,2]
Of the 599 participants, all aged 85 years at baseline, 300 (50%) had established CVD. Of these 300 participants, for 282 (94%; 109 males, 173 females) all clinical and laboratory data were available and they were included in our analyses. Of these 282 participants 55% had a history of major CVD (32% with myocardial infarction (MI) or MI on the baseline ECG, 19% with stroke and 13% with arterial surgery) and 45% had a history of minor CVD (Table 1)
In a multivariable analysis with all old and new markers, current smoking (HR 1.8), a history of major CVD (HR 1.5) and NT-proBNP (HR 1.6), were still independently associated with an increased risk of cardiovascular morbidity/mortality
Summary
Cardiovascular disease (CVD) is highly prevalent and remains a leading cause of death [1,2]. Some studies have shown incremental predictive value of new biomarkers in populations with established CVD [20,23,26,27,28,29,30,31], their predictive value in a secondary preventive setting in very old age remains unknown. Methods: In a population-based sample of 282 85-year old participants with established CVD from the Leiden 85plus Study, we studied predictive values of traditional cardiovascular risk markers, a history of major CVD (myocardial infarction, stroke or arterial surgery), and new cardiovascular biomarkers (estimated glomerular filtration rate (MDRD), C-reactive protein (CRP), homocysteine and N-terminal pro B-type natriuretic peptide (NT-proBNP)) regarding 5-year risk of recurrent cardiovascular events and mortality (composite endpoint). When estimating risk in secondary prevention in very old age, use of NT-proBNP should be considered
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